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ROYAL INSTITUTION OF CORNWALL

Founded in 1818 Patron H R H The Duke of Cornwall

Royal Cornwall Museum River StreetTruroTR1 2SJ
Telephone:01872 272205
Fax:01872 240514
e-mail:

Application form

Candidates for this post are asked to return three completed copies of this form, preferably at the above address, marked ‘confidential’ or online (). All sections of the application form need to be completed in full. CV’s will not be accepted.

Applicants selected for interview will be informed by telephone as soon as possible.

POST TITLE: Visitor Services Assistant / SALARY / WAGE: 16,000 pa pro rata
DEPARTMENT: / CLOSING DATE FOR APPLICATIONS:5th June 2016
INTERVIEW DATE (where known) : week beginning 13th June
PERSONAL DETAILS:Delete as appropriate: Ms/Miss/Mrs/Mr/Dr/other: ……………..
SURNAME ...... FIRST NAMES ......
HOME ADDRESS ......
...... POST CODE ......
HOME TELEPHONE NO ...... MOBILE NUMBER ......
EMAIL ADDRESS ......
NATIONAL INSURANCE NO (if known)…………………………………………….
Do you require a work permit to take up this appointment? ………………….
Are you a UK or EU / EEA national?......
EDUCATION/QUALIFICATIONS:(should you be selected for the post you will be asked to bring your original certificates)
DATE / NAME OF SECONDARY / QUALIFICATIONS / DATE
From / To / SCHOOL/COLLEGE/UNIVERSITY AND LOCATION / GAINED / ACHIEVED
TRAINING AND DEVELOPMENT:Please include details of any job related training and development you have undertaken which is relevant to your application
DATE
(month/year) / DURATION / COURSE TITLE/ACTIVITY / PROVIDED BY….
MEMBERSHIP OF PROFESSIONAL INSTITUTE/BODY:
NAME OF INSTITUTE/PROFESSIONAL BODY / LEVEL OF MEMBERSHIP / DATE ACHIEVED / IS YOUR MEMBERSHIP CURRENT?
CURRENT OR MOST RECENT EMPLOYMENT:
Company/Employer ...... / Post Title ......
Address ...... / Date appointed ......
...... / Notice Period ...... / Salary ......
Work telephone number ...... / Department (if applicable) ......
Main duties and responsibilities:
Date and reason for leaving:
PREVIOUS EMPLOYMENT:Most recent employer first, continue on a separate sheet if necessary. Include any periods of unemployment
EMPLOYER’S NAME / POSITION HELD / DATE / Reason for Leaving
AND ADDRESS / (include a brief description of the role) / From / To
REFERENCES: Please give details of two referees, one of whom should be your present or last employer. If you do not wish us to approach either of your referees without your permission place a cross in the box provided. Referees should be not related to you.
Name: ...... / Name: ......
Capacity in which known: ...... / Capacity in which known: ......
Address: ......
......
Post Code: ...... Tel no: ......
I do not wish my employer to be approached without my permission  / Address: ......
…………………………………………………………………….
Post Code: ...... Tel no: ......
I do not wish this referee to be approached without my permission 
KNOWLEDGE, SKILLS AND ABILITIES:
Please read the Job Description and Person Specification for the position that you are applying for and then state how your skills and abilities demonstrate that you could undertake this role. In addition, remember to include relevant experience/skills you have gained outside of paid work (for example voluntary and community work) as well as paid work.
(Attach additional sheets if necessary)
REASONS FOR APPLYING FOR THIS POST:
HOBBIES AND OUTSIDE INTERESTS:

DISABILITY DISCRIMINATION ACT 1995

This Act protects people with disabilities from unlawful discrimination. If we know you have a disability and you are selected for the job, we will make adjustments to the working arrangements or the working environment if it is reasonable in the circumstances to do so.
Do you consider that you have a disability?Yes No  (please tick as appropriate)
Please let us know if you believe there are any reasonable adjustments that would enable you to undertake the post, by attaching a separate sheet to this application with such details.

HEALTH / MEDICAL DETAILS

Are you aware of any medical condition or other medical grounds that might affect your ability to carry out the duties in the job description?
Yes No 
If yes, please give details:
CRIMINAL CONVICTIONS: (Any information given will be completely confidential)
Have you been convicted of any criminal offence other than ‘spent convictions’ as defined in the Rehabilitation of Offenders Act 1974 or do you have any charges pending? Yes  No 
If yes, please give details:
(In the event of employment failure to disclose convictions, other than spent convictions, will result in disciplinary action by The Royal Institution of Cornwall which may lead to dismissal).
ACCESS TO TRANSPORT:
Do you have a full current driving licence that allows you to drive in the UK? Yes No 
Do you have the use of a car or other form of transport? Yes No 
Data Protection Act 1998: The details given in this application form will be used during the recruitment and selection process, certain details may be processed electronically and the application form may subsequently be held on a personnel file, if you are appointed.
Please return this form marked Private and Confidential to:
[NAME)
Royal Cornwall Museum
River Street
Truro
Cornwall
TR1 2SJ / For official use only:
Acknowledge
Short list
Interview Date
Interview Time / Yes/No / Appointed
Start Date
Salary / Yes/No
DECLARATION:
I declare that the information I have given is correct to the best of my knowledge and understand that any false statement or omission may result in my application being withdrawn or my appointment being terminated.
Signature ...... Date ......